Psychotherapy and the controlled act component of psychotherapy
The component of psychotherapy that is considered a controlled act was proclaimed on December 30, 2017. The following addresses questions nurses have about psychotherapy and how this affects their nursing practice:
What is psychotherapy?
Psychotherapy is defined as “an intense client-therapist relationship which often involves the examination of deeply emotional experiences, destructive behaviour patterns and serious mental health issues.” (Health Professions Regulatory Advisory Council, 2006).
It includes a deep assessment of life processes that focus on behaviour modifications, thinking patterns, cognition, emotional response and social functioning. In order to competently practice psychotherapy, nurses need in-depth knowledge, skill and judgment.
What is the component of psychotherapy that is considered a controlled act?
The controlled act is the component of psychotherapy considered to be the highest risk to the client. It does not include all psychotherapy practices and is not defined by a technique. The Regulated Health Professions Act, 1991 (RHPA) restricts the controlled act component of psychotherapy to certain regulated professions, including nursing.
The controlled act is defined in the RHPA as:
“Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgment, insight, behaviour, communication or social functioning.”
How will I determine if I’m performing the controlled act of psychotherapy?
Based on the RHPA definition, there are five elements in the controlled act. All five elements must be met for you to be performing the controlled act:
1. You are treating a client
2. You are applying a psychotherapy technique
3. You have a therapeutic relationship with the client
4. The client has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory
5. This disorder may seriously impair the client’s judgment, insight, behaviour, communication or social functioning
It is possible you may be performing psychotherapy but not the controlled act of psychotherapy. For example, if only four of the above components apply, you are not performing the controlled act.
You are in the best position to determine whether or not you are performing the controlled act according to the criteria.
The diagram below highlights that the controlled act is one element in the wide ranging practice of counselling and psychotherapy. Many of the activities that nurses frequently engage in share some common traits with psychotherapy but they are not psychotherapy. For example, activities such as health teaching, providing information, encouragement, support or instruction are not psychotherapy.
Do I require an order to perform the controlled act of psychotherapy?
RNs and RPNs can independently perform the controlled act of psychotherapy without an order in some community settings.
It is important to note that even while you have the authority to initiate the controlled act, an order may still be required for RNs and RPNs to perform the controlled act under sector-specific legislation (For example, the Public Hospitals Act) or organizational policy.
Who can perform the controlled act of psychotherapy in practice?
In the case of the controlled act of psychotherapy, the RHPA authorizes members of 6 Colleges. These include members of:
- The Ontario College of Social Workers and Social Services Workers
- The College of Nurses of Ontario
- The College of Occupational Therapists of Ontario
- The College of Physicians and Surgeons of Ontario
- The College of Registered Psychotherapists of Ontario
- The College of Psychologists of Ontario
Are nurses able to use the title “psychotherapist”?
Yes, and you must adhere to specific regulatory requirements if you choose to use the "psychotherapist" title.
- When speaking to clients you may only describe yourself as a “Psychotherapist” if you also use your restricted nursing title .
For example: "I am an RN, psychotherapist." Or, "I am an NP and a psychotherapist."
- When describing yourself in writing, you must provide your full name as it appears on the College's Register (Find A Nurse), your protected title, and the title, "psychotherapist."
For example: Jane Goode, RN, Psychotherapist
I’m a nurse and I perform psychotherapy. Should I also register with the College of Registered Psychotherapists of Ontario?
Ultimately, this decision is up to you. As a nurse, if you have the knowledge, skill and judgment to do so, you may perform psychotherapy in your practice.
If you register with the College of Registered Psychotherapists of Ontario, this must be reported to CNO.